What is the management of conjunctivitis (pink eye)?

From the Guidelines

Pink eye, or conjunctivitis, can be managed effectively with appropriate treatment based on its cause, and the most recent evidence suggests that treatment should focus on symptom relief and prevention of complications. For viral conjunctivitis, which is most common, treatment focuses on symptom relief with artificial tears and cold compresses while the infection resolves on its own within 1-2 weeks 1. Bacterial conjunctivitis requires antibiotic eye drops such as erythromycin ointment, polymyxin B-trimethoprim drops, or fluoroquinolones like ciprofloxacin, typically used 4 times daily for 5-7 days 1. Allergic conjunctivitis responds well to antihistamine drops like ketotifen (Zaditor) or olopatadine (Pataday), used twice daily, along with avoiding allergens 1.

Key Considerations

• Good hygiene is essential: avoid touching your eyes, wash hands frequently, use separate towels, and replace eye makeup 1
• Contact lens wearers should temporarily switch to glasses until symptoms resolve 1
• While most cases of pink eye are mild and self-limiting, you should seek medical attention if you experience severe pain, vision changes, extreme redness, or symptoms that worsen or don't improve after a few days, as these could indicate a more serious condition requiring specialized treatment 1
• Herpes simplex virus conjunctivitis is a self-limited acute condition, and treatment is usually instigated upon high suspicion or concomitant corneal involvement, with possible topical options including ganciclovir 0.15% gel or trifluridine 1% solution 1

Prevention and Complications

• Early detection and treatment can be both sight saving and, in select cases, lifesaving 1
• Indiscriminate use of topical antibiotics or corticosteroids should be avoided because antibiotics can induce toxicity, and corticosteroids can potentially prolong adenoviral infections and worsen HSV infections 1
• Gonococcal conjunctivitis is a hyperacute, vision-threatening infectious condition that requires immediate systemic therapy 1
• Herpes zoster vaccination is strongly recommended in patients 50 years or older and patients 19 years or older who are immunocompromised 1

From the FDA Drug Label

For the treatment of superficial ocular infections involving the conjunctiva and/or cornea caused by Bacitracin susceptible organisms. For the treatment of superficial ocular infections involving the conjunctiva and/or cornea caused by organisms susceptible to erythromycin. The management of pink eye involves the application of ointments such as bacitracin or erythromycin directly into the conjunctival sac, 1 to 3 times daily 2, 2, 3.

• The ointment should be applied directly into the conjunctival sac.
• In blepharitis, all scales and crusts should be carefully removed and the ointment then spread uniformly over the lid margins.
• Patients should be instructed to take appropriate measures to avoid gross contamination of the ointment when applying the ointment directly to the infected eye.

From the Research

Pink Eye Management

• The management of pink eye, also known as conjunctivitis, depends on the cause of the infection, which can be viral, bacterial, or allergic 4, 5, 6, 7, 8.
• For bacterial conjunctivitis, treatment with a broad-spectrum antibiotic can resolve the problem in 1 to 3 days in almost all cases 4.
• Viral conjunctivitis is more common in adults and typically presents with watery discharge, and supportive care options include artificial tears, cold compresses, and antihistamine eye drops 5.
• Allergic conjunctivitis is typically treated with topical antihistamines with mast cell-stabilizing activity 5.
• It is essential to practice strict personal hygiene, including frequent handwashing, to decrease the risk of transmission of conjunctivitis 5.

Diagnosis and Referral

• Distinguishing between viral and bacterial conjunctivitis can be difficult, and a comprehensive history and physical examination can guide diagnosis 5, 8.
• Patients with prolonged symptoms, poor response to initial management, or evidence of severe disease should be referred to ophthalmology for consultation 5, 7.
• Ophthalmology referral is indicated for conjunctivitis in a neonate or patients with severe pain, decreased vision, recent ocular surgery, vesicular rash on the eyelids or nose, history of rheumatologic disease, or immunocompromised state 5.

Treatment Options

• Topical antibiotics are effective in treating bacterial conjunctivitis, but should not be used unless the conjunctivitis or keratitis is proven to be nonherpetic 4.
• Trifluridine (Viroptic) is preferred for treatment if dendrites are seen in viral conjunctivitis 4.
• Saline, ocular decongestants, and warm compresses may also be used in the treatment of conjunctivitis 6.